HomeMy WebLinkAboutMortgage_Hose"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �o r ip vear
___ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm d3709 (R71 / 609) ;
�' ,,,, j PresoibeE EY �P��tri of Locai GovemmeM Futarce
wsrRUCnoNS:
DE FileMark
To be filed in person a by mail with the CounryAuditor or Counry Recnrder of Ihe county where (he property is located. F� �
Filirg Dates: 1) Real P/opeRy: Must hle dufig tha year for which fhe deduc�on is soughl. County Auditor
2J Mobde / Manu(acfured Homes rrot assessed as Real Property: Must fiie dunng the 1weNe (12) months�
before March 31 of each year the deduction is sought. nry Recorder
GIBSON C
See reverse side for additional inshucdons arM qualil�cafions.
P,poGranl/oxnerorconNaCbuYe/-seerest�nlDOns�reversyside) l Y �
1/'/
eC raNe d rnal
1. aa�ent year
II ro, what Is his ! her e�ct share af intrlesY!
Recortl number Page num0u
-yo�-000. 3oq-o� � aoo 9 1033
Mortgage / Contract irMe6tedn�s unpaid az of Mongage I Contract indeWeCriess unpai0 a d Is Ihe aOW��� �e sde
Ma�U 1, cu"� t year �ate of aOP�� legal w eQUitable axneR
"i Z� _ DO Z� ❑ Yes ❑ No
If nartre on 2wN's dMerent than ihat o( a0P�4 �dinte Eebw
Name M mm9a9ee or wno-arl u9er /; � /�
/ � ��
�����-, ����
Add�ess W rtnryagee ar mntraG seAer (nimhe� end et ray. sta�. aM ZIP cade)
Name ol assiryiee w ath� owner or holder of mortgage
Add255 of assignee (numbeiaid stmel, cdy, stete, antl ZIP cade)
It ovmed wiN someone other than spoux. indifate WN whom
IS �he propeny in Quesoon: Anmlally A55e55eE
� Real ProP�tY � �Y �
Dra�r�cr \O...v��i�:......
Cas�.¢•t\��xa. 3P�.�1►� .....
� �JO�,00
Ooes ePplitlnt pm ptoperty in eny aNe� If y¢5. �M3t munlyl W1�2t ien�g U�sNCY'1
munry in Ind'au? (� Yes
n No I LJ Yes LJ No I
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